Provider Demographics
NPI:1033526991
Name:WASHINGTON, TINA NANETTE
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:NANETTE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 KENSINGTON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9084
Mailing Address - Country:US
Mailing Address - Phone:614-446-5521
Mailing Address - Fax:
Practice Address - Street 1:6137 KENSINGTON GLEN DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9084
Practice Address - Country:US
Practice Address - Phone:614-446-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057010Medicaid